Knee Injuries

Iliotibial Tibial Band Syndrome (ITBS) is a common injury that affects triathletes, runners and cyclists. Using conventional treatments, this condition never completely resolves since these treatments typically do not address all of the key structures involved in the injury.


ITBS presents as:

  • A sharp or burning pain on the lateral aspect of the knee.

  • Pain radiating up the side of the hip or thigh.

ITBS is an overuse injury caused by the repetitive action of the iliotibial band as it moves across the lateral femoral epicondyle.


The primary functions of the Iliotibial Band are to:

  • Provide static stability to the lateral (outer) aspect of the knee.

  • Control adduction (inward motion) and deceleration of the thigh.

  • During a run, the ITB performs this function about 90 times per minute, or 22,000 times during a four-hour marathon.

Anatomy and the Biomechanics of ITBS

The iliotibial band (ITB) is a wide, flat, ligamentous structure that originates at the iliac crest and inserts on the lateral aspect of the tibia, just below the knee. The iliotibial band serves as a ligamentous connection between the femur (lateral femoral epicondyle) and the lateral tibia (Gerdy’s Tubercle).

The ITB is not attached to bone as it passes between the femur and the tibia. This allows the ITB to move forward and backward with knee flexion and extension.

  • When the ITB is shortened or stressed, the repetitive motion of the knee causes friction and inflammation of the band.

  • When the knee is flexed at an angle greater than 30 degrees, the iliotibial band moves back behind the lateral femoral epicondyle.

  • During knee extension, the ITB shifts forward in front of the lateral femoral epicondyle.

With ITBS, the bursa often become inflamed, causing a clicking sensation as the knee flexes and extends.

Always Consider the Kinetic Chain

The entire kinetic chain (above and below the injury) must perform properly to ensure effectiveness of the treatment, and to ensure optimum performance at the sport. Patterns of dysfunction will develop if any segment of the kinetic chain is not functioning properly.

The ITBS Injury Process

ITBS can be caused by damage to many different soft tissues, but the underlying injury process is very similar for all the soft tissues.


Changes in biomechanics causes increased stress, internal pressure, and increased friction that leads to inflammation, and eventually, the formation of adhesions (scar tissue) within the ITB or along its kinetic chain.

Scar tissue is like glue; it restricts the translation or movement of adjacent tissues, causing friction, and leads to inflammation.


Chronic irritation leads to small tears within the ITB. This produces an inflammatory reaction. Once the inflammatory condition has started, even simple tasks such as walking can put considerable internal pressure on the ITB.

This constant internal pressure limits circulation to the tissue, resulting in decreased delivery of oxygen to soft tissues. Decreased oxygen causes several biochemical changes that result in the formation of yet more adhesions within the ITB.


This in turn creates more restrictions, inflammation, and swelling. The body responds to inflammation by laying down additional scar tissue (cross fibers across the tissue) in an attempt to stabilize the affected area. This scar tissue:

  • Restricts motion

  • Reduces circulation

  • Inhibits nerve function

  • Causes ongoing friction and pressure

  • Results in the production of yet more cross fibers and adhesions across inflamed soft tissues

It is extremely important to be as specific as possible when identifying the soft tissue structures involved in any condition. Different athletes may present with identical pain patterns at the ITB, yet they may have completely different structures that are impairing motion or causing the injury.

Before treatment takes place, an extremely accurate examination and diagnosis must be performed. It is important to look past the initial point of pain and identify all the other structures that are involved in the kinetic chain.

The Need for Accurate Diagnosis
What Should you Do During the Acute Stage of Injury

Because of the inflammatory nature of this injury, it is highly recommended that the athlete use ice massage for 3-5 minutes, over the affected area until it is numb. The more acute the condition the more essential ice massage becomes.


Usually, for conventional treatment for ITBS, a reduction or stop in training is necessary.

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